Provider Demographics
NPI:1235734641
Name:DIXON, TENASIA (LMT)
Entity Type:Individual
Prefix:
First Name:TENASIA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 E MCDOWELL RD APT 34
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3924
Mailing Address - Country:US
Mailing Address - Phone:152-034-0966
Mailing Address - Fax:
Practice Address - Street 1:8750 E MCDOWELL RD APT 34
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3924
Practice Address - Country:US
Practice Address - Phone:152-034-0966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT24949225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist